Prescription for assisting one who is hospitalized

By Joel A. Moskowitz, M D, FAAP, FAPA

LA JOLLA, California — Visiting the sick is a Jewish obligation.  The Talmud enjoins that those who visit the sick cause him/her to live  These days, it is just good health sense for you to be there  to protect a loved one who has to be hospitalized.  Deuteronomy 4:9 and 4:15, instruct us to take utmost care and “guard yourself scrupulously.”  Hospitals are places where misadventure  sadly is a frequent happening.

In my parent’s days, the patient was admitted to the hospital’s front door and frequently left through the back. We are impressed with the progress medicine has made in the past century. So why are hospitals dangerous places?   And what can be done to minimize hospital catastrophes?

As a double Board Certified (two medical specialties) physician, I have seen the hospital from the inside and as a patient, from the outside.

During a hospital stay where my colon adenocarcinoma (detected on a random survey) was successfully resected, a visiting friend saw how I had to defend my health before the overzealous nursing staff. A fellow physician, an orthopedist, had the maxim that he would not operate on any patient if the patient didn’t have someone who would stay with the patient throughout the inpatient stay.

I am fortunate to have a beautiful, intelligent and fiercely assertive wife who has been by my side now almost half a century. The incident, which took place in a nationally recognized and lauded, general hospital occurred in the day after my hemicolectomy when my measured blood pressure was uncommonly low. I have had well controlled hypertension for a decade. The nurse, who didn’t introduce herself and had no visible name tag, presented antihypertensive medication for me. With respect, I exclaimed that in the face of hypotension, it would be folly to take medications which are certain to drive my blood pressure even lower. This ‘nurse’ became instantly ‘offended and threatened that if I rejected the drugs I would be labelled an ‘uncooperative patient’!

When, following ‘orders,’ I was instructed to walk around the floor, past adjacent rooms labelled alarmingly “Caution Infection”; accompanied by my wife and an aide, I became dizzy and asked to be taken back to my room in a wheelchair. Likely a hypotensive episode. My surgeon in his usual 6:30 a.m. extremely brief rounds chided me for referring to my episode as pre-syncopal i.e. almost fainting. “You,” he asserted, “are a patient not a doctor.” Apparently there was a culture of keeping patients in their place.

My visiting friend, Jeff, was there when I had to protect my health from nursing staff and when he was hospitalized, in another reknown medical center, he was alert to protecting his health. Despite having told and written (on the myriad forms) that he had a life-long allergy to any sort of melon; was lactose intolerant; had had Bariatic surgery and must eschew aspirin, he was repeatedly brought each of these, for him, toxic substances.

Infection is rampant in hospitals. In the hospital where I had my colon resected and where my room was adjacent to rooms where quarantine precautions were in place, the staff would push a blood pressure device whose cuff was used on every patient on the floor and wrap the cuff around my arm despite my request for caution. I cannot, with certainty, link my having a wound infection requiring 21 days as an inpatient to this but nor can I can readily exclude it.

Fast forward to several years later and the setting is another famous much lauded hospital. In the interim, the practice of using ‘hospitalists’ replaced having your personal physician admit and follow you during your hospital stay. There are, to be sure, many positives in using ‘hospitalists.’ These are medical doctors who are specialists in the care of inpatients. They have never seen you, the patient before, and they won’t see you after your discharge. They are in the employ of the hospital and one might infer that is to whom their allegiance lies.

To be sure, many office-oriented physicians don’t like taking care of inpatients. They may be rusty for the more complex issues which necessitate inpatient care; they may wish to avoid possible negative outcomes; going to the hospital to visit your patient twice or more times a day is inconvenient. So the idea of hospitalists is not all bad.

Fever and chills after stepping on something in our garage provoked a visit to the Emergency Department and from there admission to the hospital.

“Cellulitis” called for two powerful IV antibiotics. My darling wife would stay by my side through the night. In a single room, all the ‘recliner’ chairs were in use and my wife was obliged to sleep on the floor. Albeit, they gave her some bedding. But I needed her presence. In past times, a suggestion might have been made to hire an aide to sit by the patient’s bed. This was not offered nor would we trust such.

Arlene was armed with a pad where she would record: who came to bring meds to me (name/rank and serial number) and what precisely were the drugs and who was the prescribing physician. The aim is not to accumulate data for a future malpractice action but to keep the staff on track.

Every room has a device which has multiple functions – one can press a button that calls the nursing station; it controls the television; another device is an archaic looking telephone; on the side of the bed there are buttons to elevate the head or the legs. No one tells you about these nor that you have to ‘order’ your meals from ‘Room Service’ (whose phone is aggravatingly busy). These are not complex challenges but when you are weak, ill, or anesthetized you are not likely to appreciate any of these tasks.

After several attempts to alert (using the call button) that my IV was beeping and required attention, my hospital telephone suddenly became inoperative! Would the administrative secretary at the nursing station disable it to silence a ‘complaining’ patient? That is paranoid. But I had a remedy; I had my cellphone!

But the hospital has “Protocol. ”Flooded with I V fluids, my bladder was overcome (I have a benign enlarged prostrate) I was unable to void. I needed a catheter. Fortunately, I thought, my urologist was, in fact, Chief of Urology in that very same hospital and I had only seen him for a routine check one week prior. None of the nursing staff nor the MD hospitalists knew his name; had doubts that he could have ‘privileges’ to see me and didn’t offer to call a urologist of their own.

I attempted to call the central number of the hospital using my cellphone and masquerading as not an inpatient. The main hospital answering operator recognized my voice (I had attempted to call and speak with administration to get my wife some place to sleep) and she refused to either connect me with administration or give me the phone number of the Chief of Urology. Ultimately, my wife obtained the number and, lo and behold, he was, in fact, the Chief of Urology in the very same hospital where I was presently a patient and though his name was not recognized, he was that very day operating in the surgery!

Lesson: have your cellphone with you and all of your doctors’ numbers loaded and anyone else you might need to call: your congressperson; the local newspaper/radio station; your attorney; the police…..

Perhaps my experience was unique specifically with respect to the hospitalists. I have no reason to suspect that they are not very well trained and expert. But in four days as an inpatient, I was visited/ made rounds on by about eight hospitalists – a different one twice a day…plus an assortment of medical students. When my bandage was not changed, after many many requests, the hospitalist who saw me that morning returned and  blamed the oversight on the medical student whom he thought had written the order. And of course, with no order, my wound remained unbandaged.

And that very same doctor who said he would have physical therapy come see me might not be surprised that it was only 15 minutes prior to discharge that physical therapy arrived. And that was shortly before a lady who introduced herself as the ‘Hospitals Advocate….” presumably for patients. She was introduced in my tale of woe. And this was followed up by a call to my home a few days later asking about my/our experiences.

It was not entirely negative. Individually, the nurses, nurse assistants, aids and doctors were anxious to be of help and they were. After all, I am home and improving.

This is not an angry rant. My purpose in describing my inpatient saga is as an illustration of adventures as an inpatient and suggestions for hopefully minimizing mishaps.

First, have someone accompany you to the hospital who will be prepared to stay with you throughout. Second, this person should be prepared to be an active advocate – interfacing with nursing staff, doctors, and even administration when necessary. Third, insist that every person who attends the patient is identified, and keep a log of the treatments/drugs given and times. Fourth: don’t be passive and simply accept what is offered to you.

You know yourself a lot better than someone who is trying to help you.

Fifth: have your cellphone with you loaded with important numbers i.e. your various physicians; relatives; and malpractice attorney (just kidding).

Hospitals are not intent on harming patients but errors occur. Some time ago, a major hotel chain thought they would get into the hospital business. Unfortunately, they didn’t go forward. A hotel provides a room which has more amenities than most hospital rooms absent having oxygen in the wall. Service and food may be more easily provided. In my active practicing days, I used local motels for patients where they sought to avoid the publicity of being identified on a hospital roll. Consults would arrive as needed. The cost (not covered by insurance) but including round the clock nursing attention was born by these celebrities.

If you can avoid inpatient treatment, that is the best therapy.

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Dr. Moskowitz is a retired pediatic psychiatrist and a frequent contributor on a variety of topics to San Diego Jewish World.  He may be contacted at joel.moskowitz@sdjewishworld.com